Why fewer beds could mean more effective ICUs

Fewer beds in intensive care units (ICUs) could help curtail variation in service use, argues an opinion piece published in the Journal of the American Medical Association.

Intensive care accounts for approximately 3 percent of healthcare spending and nearly 1 percent of gross domestic product (GDP), write Rebecca Gooch, M.D., of the University of Pittsburgh School of Medicine and Jeremy M. Kahn, M.D., of the University of Pittsburgh Graduate School of Public Health. By contrast, in the United Kingdom, intensive care accounts for only 0.1 percent of GDP.

In the U.K., Gooch and Kahn write, there are only five ICU beds per 100,000 people, and they are used almost exclusively for patients at a high risk for death. In the United States, however, there are 25 ICU beds per 100,000 people, and many ICU patients are admitted simply for observation. "At the same time, compared with patients in the United Kingdom, substantially more patients in the United States die in the ICU, suggesting that increased bed availability appears to reduce the incentive to keep dying patients out of the ICU," they write.

Gooch and Kahn tie this correlation to the economic concept of demand elasticity--the idea that a product creates its own demand. "Just as the creation of a new lane on the interstate highway can lead to increased traffic as new drivers seize the opportunity to travel on the larger road, new critical care beds can lead to increased use," they write. "As supply constraints are removed, clinicians are more likely to use the service, even for patients unlikely to benefit."

Ideally, organizations would target ICU admissions for critically ill patients, who would stand the greatest chance of benefiting from ICU care, the authors write. With a reduced ICU bed supply, hospitals would have the incentive to keep patients who would benefit from care elsewhere, out of the ICU.

A report last September found that futile care, or care that prolongs a patient's life with no beneficial effect for the patient, has cost ICUs $2.6 million, while a Michigan State University found that more hospital beds correlate with increased utilization and costs, FierceHealthcare previously reported.